Corticosteroids in Patients Hospitalized with Community-Acquired Pneumonia

Systematic Review and Individual Patient Data Metaanalysis

Ovidius Study Group, Capisce Study Group, and STEP Study Group

Research output: Contribution to journalReview article

20 Citations (Scopus)

Abstract

Background. Our aim was to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community- acquired pneumonia (CAP) using individual patient data from randomized, placebo-controlled trials and to explore subgroup differences. Methods. We systematically searched Medline, Embase, Cochrane Central, and trial registers (all through July 2017). Data from 1506 individual patients in 6 trials were analyzed using uniform outcome definitions. We investigated prespecified effect modifiers using multivariable hierarchical regression, adjusting for pneumonia severity, age, and clustering effects. Results. Within 30 days of randomization, 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo died (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], .46 to 1.21; P = .24). Time to clinical stability and length of hospital stay were reduced by approximately 1 day with corticosteroids (-1.03 days; 95% CI, -1.62 to -.43; P = .001 and -1.15 days; 95% CI, -1.75 to -.55; P > .001, respectively). More patients with corticosteroids had hyperglycemia (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60 to 2.90; P > .001) and CAP-related rehospitalization (33 [5.0%] vs 18 [2.7%]; aOR, 1.85; 95% CI, 1.03 to 3.32; P = .04). We did not find significant effect modification by CAP severity or degree of inflammation. Conclusions. Adjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately 1 day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalization and hyperglycemia.

Original languageEnglish (US)
Pages (from-to)346-354
Number of pages9
JournalClinical Infectious Diseases
Volume66
Issue number3
DOIs
StatePublished - Jan 18 2018

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Pneumonia
Adrenal Cortex Hormones
Confidence Intervals
Length of Stay
Odds Ratio
Hyperglycemia
Placebos
Random Allocation
Cluster Analysis
Randomized Controlled Trials
Inflammation
Mortality

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Corticosteroids in Patients Hospitalized with Community-Acquired Pneumonia : Systematic Review and Individual Patient Data Metaanalysis. / Ovidius Study Group, Capisce Study Group, and STEP Study Group.

In: Clinical Infectious Diseases, Vol. 66, No. 3, 18.01.2018, p. 346-354.

Research output: Contribution to journalReview article

Ovidius Study Group, Capisce Study Group, and STEP Study Group. / Corticosteroids in Patients Hospitalized with Community-Acquired Pneumonia : Systematic Review and Individual Patient Data Metaanalysis. In: Clinical Infectious Diseases. 2018 ; Vol. 66, No. 3. pp. 346-354.
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title = "Corticosteroids in Patients Hospitalized with Community-Acquired Pneumonia: Systematic Review and Individual Patient Data Metaanalysis",
abstract = "Background. Our aim was to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community- acquired pneumonia (CAP) using individual patient data from randomized, placebo-controlled trials and to explore subgroup differences. Methods. We systematically searched Medline, Embase, Cochrane Central, and trial registers (all through July 2017). Data from 1506 individual patients in 6 trials were analyzed using uniform outcome definitions. We investigated prespecified effect modifiers using multivariable hierarchical regression, adjusting for pneumonia severity, age, and clustering effects. Results. Within 30 days of randomization, 37 of 748 patients (5.0{\%}) assigned to corticosteroids and 45 of 758 patients (5.9{\%}) assigned to placebo died (adjusted odds ratio [aOR], 0.75; 95{\%} confidence interval [CI], .46 to 1.21; P = .24). Time to clinical stability and length of hospital stay were reduced by approximately 1 day with corticosteroids (-1.03 days; 95{\%} CI, -1.62 to -.43; P = .001 and -1.15 days; 95{\%} CI, -1.75 to -.55; P > .001, respectively). More patients with corticosteroids had hyperglycemia (160 [22.1{\%}] vs 88 [12.0{\%}]; aOR, 2.15; 95{\%} CI, 1.60 to 2.90; P > .001) and CAP-related rehospitalization (33 [5.0{\%}] vs 18 [2.7{\%}]; aOR, 1.85; 95{\%} CI, 1.03 to 3.32; P = .04). We did not find significant effect modification by CAP severity or degree of inflammation. Conclusions. Adjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately 1 day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalization and hyperglycemia.",
author = "{Ovidius Study Group, Capisce Study Group, and STEP Study Group} and Matthias Briel and Spoorenberg, {Simone M.C.} and Dominic Snijders and Antoni Torres and Silvia Fernandez-Serrano and Gianfranco Meduri and Albert Gabarr{\'u}s and Blum, {Claudine A.} and Marco Confalonieri and Benjamin Kasenda and Siemieniuk, {Reed A.C.} and Wim Boersma and Bos, {Willem Jan W.} and Mirjam Christ-Crain",
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T1 - Corticosteroids in Patients Hospitalized with Community-Acquired Pneumonia

T2 - Systematic Review and Individual Patient Data Metaanalysis

AU - Ovidius Study Group, Capisce Study Group, and STEP Study Group

AU - Briel, Matthias

AU - Spoorenberg, Simone M.C.

AU - Snijders, Dominic

AU - Torres, Antoni

AU - Fernandez-Serrano, Silvia

AU - Meduri, Gianfranco

AU - Gabarrús, Albert

AU - Blum, Claudine A.

AU - Confalonieri, Marco

AU - Kasenda, Benjamin

AU - Siemieniuk, Reed A.C.

AU - Boersma, Wim

AU - Bos, Willem Jan W.

AU - Christ-Crain, Mirjam

PY - 2018/1/18

Y1 - 2018/1/18

N2 - Background. Our aim was to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community- acquired pneumonia (CAP) using individual patient data from randomized, placebo-controlled trials and to explore subgroup differences. Methods. We systematically searched Medline, Embase, Cochrane Central, and trial registers (all through July 2017). Data from 1506 individual patients in 6 trials were analyzed using uniform outcome definitions. We investigated prespecified effect modifiers using multivariable hierarchical regression, adjusting for pneumonia severity, age, and clustering effects. Results. Within 30 days of randomization, 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo died (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], .46 to 1.21; P = .24). Time to clinical stability and length of hospital stay were reduced by approximately 1 day with corticosteroids (-1.03 days; 95% CI, -1.62 to -.43; P = .001 and -1.15 days; 95% CI, -1.75 to -.55; P > .001, respectively). More patients with corticosteroids had hyperglycemia (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60 to 2.90; P > .001) and CAP-related rehospitalization (33 [5.0%] vs 18 [2.7%]; aOR, 1.85; 95% CI, 1.03 to 3.32; P = .04). We did not find significant effect modification by CAP severity or degree of inflammation. Conclusions. Adjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately 1 day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalization and hyperglycemia.

AB - Background. Our aim was to evaluate the benefits and harms of adjunctive corticosteroids in adults hospitalized with community- acquired pneumonia (CAP) using individual patient data from randomized, placebo-controlled trials and to explore subgroup differences. Methods. We systematically searched Medline, Embase, Cochrane Central, and trial registers (all through July 2017). Data from 1506 individual patients in 6 trials were analyzed using uniform outcome definitions. We investigated prespecified effect modifiers using multivariable hierarchical regression, adjusting for pneumonia severity, age, and clustering effects. Results. Within 30 days of randomization, 37 of 748 patients (5.0%) assigned to corticosteroids and 45 of 758 patients (5.9%) assigned to placebo died (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], .46 to 1.21; P = .24). Time to clinical stability and length of hospital stay were reduced by approximately 1 day with corticosteroids (-1.03 days; 95% CI, -1.62 to -.43; P = .001 and -1.15 days; 95% CI, -1.75 to -.55; P > .001, respectively). More patients with corticosteroids had hyperglycemia (160 [22.1%] vs 88 [12.0%]; aOR, 2.15; 95% CI, 1.60 to 2.90; P > .001) and CAP-related rehospitalization (33 [5.0%] vs 18 [2.7%]; aOR, 1.85; 95% CI, 1.03 to 3.32; P = .04). We did not find significant effect modification by CAP severity or degree of inflammation. Conclusions. Adjunct corticosteroids for patients hospitalized with CAP reduce time to clinical stability and length of hospital stay by approximately 1 day without a significant effect on overall mortality but with an increased risk for CAP-related rehospitalization and hyperglycemia.

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DO - 10.1093/cid/cix801

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JF - Clinical Infectious Diseases

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